Pre-hospital trauma life support (PHTLS) advanced provider course

Abstract

Overall, the course is a good product, delivering mostly useful information in a relaxed but educationally sound manner. The course is however rigid and there is only one way, the PHTLS way, especially when it comes to spinal immobilisation and on scene interventions. At present, few Australian pre-hospital providers go to the extremes of immobilising the cervical spine as is the case in the US and this (personally) became a little frustrating. The course is probably most suitable and valuable for team members in rural and remote areas where there are limited resources and exposure and in as much, a system such as PHTLS principles is likely to deliver reasonable quality care. Other groups to which the course would be valuable include predominantly in-hospital care providers (including Doctors and Nurses) who may have limited experience in the out-of-hospital setting, as the course provides rapid acquisition of knowledge and skills in a compact and efficient format. In terms of practising Ambulance Paramedics and Intensive Care Paramedics, what you get out of the course will vary depending on your background and experience. Junior staff would find the course valuable. More senior staff however may or may not find the course valuable and/or enjoyable. Nevertheless, irrespective of your knowledge, experience and training, it is important to reflect on your own practice from time to time, and this course provides the opportunity to do this. There is certainly valuable content in the course and ample opportunity to consolidate skills (even if performed differently to what you are used to). There was an emphasis on principles (covered nicely in Chapter 15) [2] namely: scene assessment; primary survey (and cervical spine immobilisation) with a "treat as you go" philosophy [of note: - the PASG is still included with limited indications]; recognising time critical incidents (life threatening or multi-system injuries); minimising scene time (the Platinum 10 minutes of the Golden Hour) including "limited scene intervention" [of note: - cannulation was not generally considered part of the limited scene intervention]; initiation of rapid transport to "closest appropriate facility". Interestingly, iv access, iv fluids, secondary survey and medical history were all indicated only after initiation of rapid transport. Whilst we agree in principle with not wasting time on scene, that we, like many of out pre-hospital colleagues believe, iv access can and should be established in an opportunistic fashion where possible, and that this (in most circumstances) will not "waste time" and can be achieved (concurrently with other priorities, depending on resources) in the Platinum 10 minutes. The ability to establish two large bore cannulas enroute as the text suggests, adds (in our opinion), increased difficulty, decreased safety and a potentially more compromised patient. Obviously, if the patient is ready to be transported and iv access has not been established, then of course this should be done enroute.